Eating Well

By Marian Burros

Published: March 29, 1995

THE selling of the Mediterranean diet pyramid through articles and cookbooks is proceeding at a breathtaking pace. Food writers who never liked the United States Agriculture Department's Food Guide Pyramid have embraced the Mediterranean version with gusto. The primary difference between the two, and the one that endears the Mediterranean pyramid to food writers, is the recommendation that generous quantities of olive oil be used.

The Mediterranean pyramid is the creation of Oldways Preservation and Exchange Trust, a nonprofit group that holds conferences on food, culture and diet; the Harvard University School of Public Health, and the World Health Organization. It is based on the fact that Mediterranean people have traditionally had very low rates for heart disease and certain types of cancer.

The International Olive Oil Council, a trade association of countries that produce olive oil, has spent about $2 million a year to finance Oldways conferences on the Mediterranean diet in Greece, Morocco, Spain, Tunisia and Turkey. Those who attend include journalists, cookbook authors, chefs, restaurateurs and scientists. Financing has also come from the wine industry.

While both the Mediterranean pyramid and the Food Guide Pyramid recommend a diet based largely on grains, fruits and vegetables, they differ in important ways. The Mediterranean diet recommends 25 to 40 percent of calories from fat, most of it from olive oil. Mainstream dietary advice, including the Food Guide Pyramid, recommends 30 percent of calories from fat or less.

The Mediterranean diet was created by Dr. Walter Willett, Dr. Frank Sacks and others at the Harvard School of Public Health along with Oldways and the W.H.O. Dr. Willett and Dr. Sacks suggest red meat either a few times a month or no more than one ounce a day, four to six ounces of poultry three or four times a week and four to six ounces of fish three to seven times a week. The Food Guide Pyramid lumps red meat, fish, poultry and beans together and suggests four to nine ounces daily.

The Mediterranean pyramid puts beans in a separate category with legumes and nuts and recommends that foods from this category be eaten daily. It also recommends daily physical activity, and it makes an optional recommendation that some wine be consumed daily.

The idea of eating the way people who live in the Mediterranean used to eat has enormous appeal to people who are really interested in food, because they associate Mediterranean cuisine not only with exploding flavors but also with pasta, olive oil and wine. To these people the diet sounds much more appetizing than one that limits fat of all kinds, including olive oil, and calls for low-fat cheeses and low-calorie salad dressings, steamed instead of sauteed vegetables, and the like.

The first survey of the relationship between diet and heart disease, in the 1960's, was based on the diet of Cretans, whose death rate due to heart disease was seven times lower than that for American men of the same age. Since that time Cretans have been increasing their intake of saturated fat and decreasing their intake of olive oil. They are also less physically active. By the 1980's their rate of heart disease had risen almost 30 percent.

For years health professionals have been trying to convince Americans, without much success, that they must reduce their consumption of total fat and saturated fat by reducing the amount of animal protein and sweets in their diets. Americans love their beef and their sweets. So they continue to eat the animal protein and have switched from fat-laden cookies and ice cream to fat-free versions. Instead of one serving of full-fat ice cream they eat the entire container of fat-free ice cream, simply replacing the calories from fat with calories from carbohydrates. Total fat consumption has dropped slightly, but Americans continue to grow fatter.

When Americans are faced with dietary advice they don't want to follow, they tend to cherry pick, and detractors of the Mediterranean diet think it will encourage them to do the same thing: instead of reducing consumption of animal protein, eating more fruits, vegetables and grains and increasing physical activity, they will simply add olive oil to their current diet.

Bonnie Liebman, the director of nutrition for the Center for Science in the Public Interest, a consumer advocacy group, said the Mediterranean pyramid will give people license to eat more fat. "My hunch is people think it means pouring more olive oil over salad or using more in the frying pan," she said.

Ms. Liebman acknowledges that the Food Guide Pyramid is not ideal, because it makes no distinction between beans and hot dogs, ice cream and yogurt. She said: "The best advice is the Mediterranean diet without all the olive oil."

While the scientific community agrees that Americans consume too many calories for their generally sedentary lifestyle, they disagree on how to change that.

Dr. Willett said he didn't think there was "any evidence in this country to support lowering the percentage of fat from calories as any solution to obesity." The solution, he said, is calorie control and more exercise. By exercise, Dr. Willett said, he means "20 to 25 minutes or more a day of intense physical exercise -- jogging, the Nordic Track, fast bicycling, brisk walking, Rollerblading, squash and stair machine."

But much of the rest of the medical community agrees with Dr. Ernest Schaefer, a professor of medicine and nutrition at Tufts University School of Medicine, who believes in fat restriction. "There is a lot of data to support that if a diet is restricted in fat and high in carbohydrates, such diets are not as calorically dense and people lose weight," he said.

Dr. Jeanne Goldberg, an associate professor of nutrition at Tufts University, said that "a diet that is high in fat is harmful because it's much harder to control calories on a high-fat diet and the public has trouble counting calories."

What's more, the public is dismayed by the conflicting advice.

"I think the public is confused," Dr. Goldberg said. "Putting out two pyramids only adds to public confusion. The U.S.D.A. pyramid has a lot of strengths and is in step with the way Americans eat. To impose another way of eating from another time is a formidable task. Dr. Schaefer is also disturbed by the optional-wine recommendation. "Alcohol has so many negative effects," he said. "It is related to a number of cancers -- esophagus, oral, rectal and breast."

Even though Dr. Scott Grundy, director of the Center for Human Nutrition at the University of Texas Health Sciences Center in Dallas, thinks a diet with 35 percent fat may work as well as a diet with 30 percent fat, he takes the middle road. "Either of the pyramids is equivalent in terms of health benefits," he said. "I don't favor oversimplification. I would rather the diet message be more moderate and discuss the dangers of too much fat and too much carbohydrate."